Monday, July 26, 2010

The Age of Anomie?

"Message: I care."

George H. W. Bush

The mad have always been with us--convincing descriptions of severe mood disorders in particular exist from antiquity. But neuroses and "problems of living," or at least the recognition thereof, are largely inventions of modernity, as set forth by Ronald Dworkin in his account of what he calls "the caring industry." His article is not brief but presents some fascinating arguments and warrants careful reading. I have time for only a short summary and response here.

As Dworkin describes, since the 1950's a massive population of therapists of every stripe and, now, "life coaches," has sprung up to manage emotional issues that until then had been the domain of traditional peer groups, lines of authority, and cultural connectedness. The rise of mobility and suburbanization and the decay of natural communities began this trend, which was reinforced and hastened by the social turmoil of the 1960's and onward. Therapists do the work (or try to) that used to be done (if it was done at all) by families, neighbors, and the clergy.

So far this is pretty familiar territory--Dworkin documents the increasing ubiquity of the caring industry in the military, the schools, and everyday life. He points out that while the 1950's are often recalled as a calm before the storm of contemporary upheaval, the decade was, beyond its infamous conformity, actually marked by a deep malaise, reflected in its moniker as "the Age of Anxiety." It was as if the plunge into collective and rapid social and technological change, still a few years off, could nonetheless be glimpsed and feared.

But Dworkin's more creative and radical claim is that, presumably in response to the civilization-wide catastrophes of the two world wars, people in the West at mid-century underwent a profound change in their emotional engagement, one that we still haven't recovered from. He suggests that for the better part of a millenium, love had grown as an ideal in personal, religious, and national life. But the extent and depravity of the world wars showed that love stops at the nation-state and cannot be extended to humanity as a whole; the implication is that love is not only insufficient for global security, it is positively dangerous, and an unaffordable luxury, inasmuch as it fosters tribalistic nationalism in a nuclear age.

The consequence was that people have tended to grow more detached and cynical in their attachments. Much of the residual lure of love, intensified by the entertainment industry, has come to reside in individual erotic connection, upon which more and more seems to ride even as it becomes more fragile. Dworkin argues that people have largely given up on the organic, intense, but volatile attachments to natural peer groups in favor of cooler, more easily manageable relationships obtainable from therapists in finely titrated 50-minute increments. It is an elaborate theoretical version of the therapist-as-friend-substitute claim.

There is much that could be said in response to this fascinating version of history. First, while he does not come out and say so, Dworkin's elegaic tone certainly evokes some Golden Age when people were happier--is that really the case? While he suggests that the masses are lonely and miserable, most surveys of Americans at any rate show that the majority consider themselves basically happy (I am aware of the myriad nuances surrounding a fraught construct such as happiness). To be sure, attachments are not so simple, so monolithic, or so geographically given as they long were, but are they worse? Perhaps they are more dynamic, more flexible.

For some reason Dworkin refers primarily to the traumas of the war-ridden early 20th century, but it seems to me that the nuclear age contributed more directly to civilization-wide angst. For 65 years now the possibility of nuclear holocaust has been a gun held to the head of humanity, and it has not gone away, even if we don't so much envision a Soviet premier with his finger on the button. For those so inclined, the environmental threats of recent decades have added to the perceived risk of the earth being ruined beyond repair. These things, it seems to me, could sap social trust and confidence more than the legacy of the trenches and the Holocaust, horrible though they were.

Dworkin maintains that people utilize "the caring industry" on a massive scale because they have grown more sad and alienated. However, by this argument, one could argue that people use air conditioning because they have grown hotter than people of previous centuries. The latter would of course be wrong, but one can make a case that psychotherapy is not so much a response to cultural calamity as it is just another modern innovation that people find useful and reassuring. The comparison to air conditioning may sound trivializing, but it isn't entirely far-fetched; after all, in heat waves such as we are having now in my part of the world, AC does save lives, even if for most it "merely" adds to quality of life.

It is true that air conditioning has made people less tolerant of the heat, just as automobiles make people on average less tolerant of exercise. But these are side-effects and trade-offs that the majority seem willing to make. And the relative softness and sensitivity of modern populations are arguably consequences of unheralded prosperity--there is a bit of a princess-and-the-pea phenomenon whereby the better off on is, the less tolerant one becomes of imperfection. Most people in history had no need of therapy because they were too busy trying to stave off starvation and disease.

Modern psychotherapy arose in Europe in the 19th century, which on that continent on average was a time of great prosperity; suddenly there was a larger middle class with the time and disposable income to worry about the kinds of "problems of living" that traditionally could be "suffered" only by the rich. It is significant then that psychotherapy really took off in the U. S. in the 1950's, which, while it was a time of war weariness and nuclear anxiety, was also in economic terms the start of a globally novel degree of economic well-being.

Despite its inequalities (more stark in recent years), over the past half-century the U. S. has been, in sum, the most prosperous nation in the history of the world, so arguably its vices--the breakdown of the family, the hypertrophic media and entertainment industries, the rise of obesity, and yes the "triumph of the therapeutic"--are largely ailments of prosperity. But these ailments are very real, and attended by real suffering--just ask the morbidly obese. The caring industry may be an inevitable result of liberal capitalism. As a culture, it may be that we have become less trusting, and perhaps even less loving, than our great-grandparents, but arguably we are also more knowing and less naive.


Novalis said...

It occurs to me that on this account, according to the old SF trope, the only thing that provoke love of humanity would be an invasion by aliens. That presumably would put therapists out of business for a while. Maybe the APA can bribe them to stay away (it would be another excuse for raising dues anyway).

Anonymous said...

Extensive utilisation of psychologists/psychiatrists
by the US military is definitely motivated by 'care'. Not in th direction of the traumatised soldiers, but rather
the military apparatus itself. A well-oiled machine with greater durability of its functioning parts is more effective, and has greater moral, political and social justification for sucking society's resources in aide of bloating its superpower ego...

Is society necessarily sadder and lonelier with increasing
psychiatric needs than ever before? It's just a more complex machine, and hence has more opportunity for malfunction. The underlying genetic beast that silently writhes awaiting a provocative nudge is qualitatively the same. Society now plays multiple Russian roulette games simultaneously and each game modifies the others, sometimes attenuating their influence, other times accelerating the inevitable.

Why should people burden friends and families with their psychic ills?? (well yes, I do mean burden if there is a better alternative and a choice is made to the contrary and to everyone's detriment. There are limits to being there for someone). Psychotherapy is not a social/interpersonal cop-out. It's not about self-absorption (...maybe for some it is). It's about making the self more available/viable for the main absorption - a successful function of the social collective. Everything in its right place, always.

Novalis said...

Yes, I agree--in the military one is fashioned into a weapon above all, and it will not do to have the blade dulled by emotional distress.

And like you say, move moving parts, or as I've written here before, more choices to a degree that bewilders.

Dr X said...

I had funny reaction to the article. I couldn't help asking: what dog does he have in this fight? I'm not suggesting the subject is unworthy of investigation and discussion. The rapid rise of psychotherapy in the US is an interesting phenomenon. It was just a question that, for some reason, I couldn't shake off while I was reading.

Novalis said...

Yes, that's a good way of putting it. The growing prominence of the mental health professions is usually tacitly viewed as A Bad Thing, perhaps because of the implicit sense of substitution for the weakening balms of religion. Maybe it's a bit analogous to the ubiquity of lawyers as a reflection of flawed humanity--why can't we all just naturally get along and be content?

moviedoc said...

Could it be that anxiety varies directly with knowledge and choice?

Psychotherapy is not monolithic. While the goals of some methods seem to be helping the person to be a better patient who remains in treatment longer (long term therapy better than short term) in my training in family systems the goal was to help the patient get what they need from the important people in their life and fire me ASAP.

James said...

Fortunately, love is and always will be a personal choice.